内科学 内分泌和代谢性疾病总论 英文课件

Endocrine&MetabolicDiseasesTheDepartmentofEndocrinologyandMetabolismKeypointsToknowendocrinesystemandhormonesTograsptheprincipleofdiagnosisandtreatmentofendocrinediseasesContentsEndocrinesystemandHormonesDiagnosisofEndocrineDiseasesTreatmentofEndocrineDiseasesProgressContentsEndocrinesystemandFunction(1)Endocrineglandsandcells(2)Hormone&function(3)Regulationofhormone(4)Mechanismofhormoneaction(5)MetabolismofhormoneEndocrinesystemGlands+Cells（APUD）HormonesCRH、GnRH、TRHGHRH,GHRIHPIF,PRIF,ADHACTH,TSHFSH,LH,GHPRL,ADHTH(T3,T4)CacitoninePTHInsulin,C-pSS,GlucagonEstrogenProgesteroneGlucocorticoidAldosteroneTestosteroneCatecholamineTestosteroneEndocrineCells&HormonesLeptin,Adiponectin,Resistin,VisfatinetalAdipocytesEndotheliumcellsNO，EndothelinAPUDcells(amineprecursoruptakeanddecarboxylation)PeptideorCatecholemineHormone

ClassificationPeptidesorProteins:GH,InsulinAmineorAminoAcidAnalogs:THCatecholamines,E,NESteroids:Cortisol,T,E,VitDFattyacidderivatives:prostaglandinHormoneSecretionNeuroendocrine:EndocrineParacrineAutocrineIntrarine⑥Neurocrine:⑦Solinocrine:PulsatileandRhythmsSecretionPulsatileorcyclicsecretion:likesawaveT4changeinseasonFSH,LH,E,andPchangeinwksInsulin,PRL,GnRHfrommin.tohr.HormoneRhythmsSecretionDiurnalrhythmACTHandcortisol:8am/4pm/midnight

Sleep-associatedrhythmsGH，ProlectinOnehormone,MultiplefunctionsOnefunction,MultiplehormonesAntagonismofhormonesHormoneAction&InteractionEg.HyperglycemiavshypoglycemiaHormoneRegulationNervous-Endocrine-ImmunesystemNervous-Endocrine-MetabolismEndocrineandEndocrineHypothalamus-pituitary-targetglandsFeedbackRegulation

Nerveimpulse&CytokinesHypothalamusPituitaryTargetGlandsNevercenterABCDTHSecretionRegulationAxis

TRHTHHypothalamusPituitaryThyroidTSHCortisolSecretionRegulationAxisACTHCRHCortisolHypothalamusPituitaryAdrenalGonadalHormoneSecretionRegulationAxisFSH,LHGnRHE2,P,THypothalamusPituitaryGonadsOtherHormoneRegulationAxisRenin-angiotensin-aldosteronesystem(RAA)Energy-metabolicregulationsystemPTH-Cacitonine

-1,25(OH)2D3HormoneReceptormembranereceptor(4types):PeptidesorProteinsnuclearandcytoplasmicreceptor

Steroids,TH,VitD①②②ContentsEndocrinesystemandHormonesDiagnosisofEndocrineDiseasesTreatmentofEndocrineDiseases2.EndocrineDiseasesClassificationHyperfunction(2)Hypofunction(3)

Abnormal

responsetohormone:Sensitiveorresistant(4)

Tumor:SecretehormonesordestroyglandsDiagnosisofEndocrineDiseases(1)Function(2)Location(Anatomy)(3)CausesSymptoms&SignsSymptoms&signsDiseasesWeightgainHypothalamicsyn.Cushingsyn.Hypothyroidism,InsulinomaWeightlossAdrenalinsufficiency,Hyperthyroidsm,DM,Hypopituitarism,PheochromocytomaShortstatureIdiopathicGHdeficiency(Dwarfism),Turner’ssyn.TallstaturePituitarygiganism,Klinefeltersyn.Symptoms&SignsSymptoms&signsDiseasesPolyuria

Diabetesinsipidus,Diabetesmellitus,Hypercalcemia,Hypokalemia

Hyperpigmentation

Addison’ssyn.Nelson’ssyn.HypopigmentationPanhypopituitarismAcneAndrogenexcess,PCOS,Cushingsyn.StriaeCushingsyn.Symptoms&SignsSymptoms&signsDiseasesDecreasedbodyhairHypothyroidism,HypopituitarismHirsutismAndrogenexcessstates,Cushingsyn.AmenorrheaAdrenalinsufficiency,Cushingsyn.Hyperprolactinemicstates,PCOS,Hypopituitarism,OvarianfailureGalactorrheaHyperprolactinemicstates,Prolactinomas,HypothyroidismSymptoms&SignsSymptoms&signsDiseasesProptosisGraves’disease,ObitaltumorHypokalemiaPrimaryaldosteronism,ParalysisRenin-secretingtumorsCushingsyn.AcanthosisnigricansObesity,PCOS,Acromegaly,Severeinsulinresistance,Cushingsyn.BonepainOsteoporosis,Hypercalcemia,HyperparathyroidismSymptoms&SignsSymptoms&SignsThelevelofhormone(Bloodorurineorsalivary)

SerumPRL,GH,ACTH,TSH,FSH,LH,Insulin,T3,T4,PTH,T,E2,P,AldoUrineCortisol,SalivarycortisolBasallevels:FT3,FT4,TSHHormone’srhythm:ACTH-Cortisol(8/15/24)Biochemicalindex:BG,Ca,K,Na,PLaboratoryTestsDynamic(functional)testsStimulationtest:

onhypofunctiondiseaseeg.TRH,ACTH,OGIRTSuppressiontest:

onhyperfunctiondisease.eg.dexmethasonesuppressiontestonCushing’ssyndrome.LaboratoryTestsLocalizationofDisordersLocalizationImagingstudies:MRI,CT,ECT,BultrasoundSamplesformeasurementofhormoneviacatheterCauseofDisordersCausediagnosis

Chemistryanalysis:urineiodineImmunoassay:IAA,ICA,GAD,TPOAb,TgAbGeneticanalysis:DNAanalysis,chromosomePathology:Fine-needlebiopsy,operationsampleDiagnosisofEndocrineDiseases(1)Symptoms---Strange(2)Signs---Inspection(3)LabTests---Function(4)CausesorLocalization3.TreatmentofEndocrineDiseases(1)Tocauses(2)Correctmetabolicabnormity(3)SpecialtreatmentCausesofHypofunctionDestructionofthegland:autoimmune,tumor,infection,surgery,radiation,hemorrhage.Extraglandulardisorders:renalCongenitaldefectsinhormonebiosynthesisReceptorDeficiencyDrugsDefectsinSensitivitytoHormoneType2diabetesmellitusPseudohypoparathyroidismSomehypothyroidismNephrogenicdiabetesinsipidusRickets(vitaminDinsensitivity)

TreatmenttoHypofunctionReplacementwithhormoneinaphysiologicmanner:insulin,THReplacementwithhormonemimics:VitaminDR